Latest Ebola update from doctors on the ground in west Africa

I’ve been following some first-hand reports from doctors on-the-ground in Liberia, who are trying to help contain the Ebola outbreak in west Africa, and the reports are somewhat different from what we are hearing from the media.  The outbreak has hit Liberia, Guinea and Sierra Leone.

One doctor is a pediatrician and specialist in infectious diseases.  He has been sending back first-hand information, and things he’s gleaned from other health care professionals in the area.

There are also a few other doctors on the site who have been to Liberia recently, working in clinics there.  One just returned July 1st of this year.  So they’ve been adding their stories, as well.

They suspect that many of the Liberians may be avoiding getting medical treatment from doctors and hospitals.  One fear many locals have is that the foreign doctors have brought the virus with them, and that they will use it to kill Liberians and use their bodies as donors for transplantation of organs.  The fear is that possibly, up to 75% of people who may be having symptoms of a fever are staying home, possibly traveling to relatives or may be using local healers.  Of course, those with Ebola who do this can be spreading the disease to those that they come into close contact with.

Ebola virus, courtesy of the CDC.

Ebola virus, courtesy of the CDC.

One of the doctors points out that most Liberians have malaria, and an attack of malaria can present much like Ebola.  So when local health care workers, often nurses, see a patient with a fever, diarrhea and/or vomiting, they think of malaria and start malaria treatment.  They may also think of typhoid fever or gastroenteritis, also very common and try to treat those.  The point is, they are not thinking of Ebola.  And even if they do consider Ebola, there is only one lab, in each of the countries where the epidemic is occurring, that can test for Ebola.  And testing takes time.  A blood specimen has to be drawn in the clinic, transported to the central lab, the test set up and run, then the results have to be gotten back to the clinic.  If positive, the patient then has to be found and isolated.  It would be impossible to quarantine all of the patients who show up each day at clinics with symptoms that might be Ebola.  The clinics are usually fairly small, cramped, have very limited supplies and equipment.  Hospitals in the area are not much better equipped.  So even the patients who show up at a hospital with Ebola-type symptoms cannot all be effectively isolated.  This makes containment even more of a problem.

Other sources also show that the situation in this region continues to deteriorate.

Additionally, groups of local people have attacked and burned some of the clinics, because of their fear mentioned above, that the clinics and hospitals are spreading the disease.  At one point, police were called out to disperse a group by using tear gas on them.

Measures to prevent the spread of Ebola by screening travelers are not going as well as hoped. Some people are trying to get on flights (or find other ways out of the area via auto, boats, etc.) while avoiding screenings.  They may to slip past the screeners or bribe them.  Some airlines have stopped flights in to and out of the affected areas.  Med evac missions are also not allowed to leave the area.  So anyone who is ill with any problem, must be treated locally.

Local containment measures also include decontamination of reusable equipment (e.g., the boots that workers must wear). Bedding, clothes and other items that might be contaminated with Ebola need to be burned.  Body fluids and waste from victims has to be destroyed.  And the bodies themselves need to be handled appropriately to prevent spreading Ebola.  However, not all families are willing to forgo their own death and burial rituals that can lead to spread of the virus.

CDC, WHO and other groups say that the chance of Ebola spreading out of the region is low.  But they want health care professionals worldwide to be aware of Ebola symptoms, in case someone flies from Africa to another country and then falls ill. US doctors, for example, do not automatically think “Ebola” when a patient walks in with fever, diarrhea and vomiting.  Several US medical groups and societies have emailed their members with information concerning Ebola and its symptoms.  They want primary care doctors (family medicine doctors, internal medicine doctors, ER doctors and ICU doctors) to be aware of what is going on regarding the epidemic, the natural history of the disease, how to look for possible cases, testing options, etc.

One hospital emergency department in North Carolina responded appropriately when it thought that it might have gotten a patient who could have had Ebola.  They locked down the ER until they made sure that the patient was not at risk for having Ebola.

But vigilance is necessary.  The Liberian-American businessman who died of Ebola in Nigeria was planning to visit his family in Minnesota after he finished his business in Lagos.  It is possible for the outbreak to spread beyond Africa’s borders.

Public health officials think that should Ebola escape from Liberia-Guinea-Sierra Leone-Nigeria that it may show up in France first. There are many flights from Africa to France.  France, some French businesses and some French citizens have close ties to Africa.

One group of US healthcare workers that was planning to leave for the Ebola-infected area today, canceled its plans.  They are worried about the virus and the local conditions where health care workers may be assaulted. The Peace Corps is bringing all of its personnel out of the three countries where the epidemic is at its worst. There is some speculation that additional relief and medical works will not be allowed to enter these areas because of the danger from the virus and from some of the citizens.

I’ll update this information if I become aware of other developments.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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